NPIMap

Individual provider Active NPI

Gregory Charles Grahek, NP-BC

  • Acute Care Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1558554188
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
173720-5414 Issued in CO
Practice address
1619 N Greenwood St Ste 208
Pueblo, CO 81003-2656
Phone
(719) 564-4336
Fax
(719) 561-8469
NPI assigned
Aug 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5441 CO
Acute Care Nurse Practitioner 363LA2100X 173720-5414 CO Primary

Addresses

Primary practice location

1619 N Greenwood St Ste 208
Pueblo, CO 81003-2656

Mailing address

1619 N Greenwood St Ste 208
Pueblo, CO 81003-2656
Phone (719) 671-4629

Other identifiers 2

IdentifierTypeStateIssuer
333409528MedicaidCO
RXN 08-123OtherCOSTATE RXN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070924000065 CO Practitioner - Nurse Practitioner 4981798873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ted J Puls MD PCGroup PAC ID 5294703831, 3 clinicians

Practice addresses (Care Compare)

1619 N Greenwood St
Suite 208
Pueblo, CO 81003-2656
Phone (719) 561-4336

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Colorado Springs, CO, CCN 067449
  • St Mary-Corwin Hospital Hospital, Pueblo, CO, CCN 060012
  • Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
173720-5414COMDAcute Care Nurse Practitioner
5441COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ted J Puls MD PC CurrentSince Jan 1, 2025 Accepting new patients
Heritage Internal Medicine, PC PastSince Feb 1, 2020 Accepting new patients
Inpatient Consultants of Colorado, PC Past Accepting new patients
Inpatient Consultants of Colorado PC Past Accepting new patients

Locations

1619 N Greenwood St
Ste 208
Pueblo, CO 81003
Phone (719) 543-6633

1619 N Greenwood St
Pueblo, CO 81003
Phone (719) 542-9010

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1558554188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST STE 208",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032656",
            "telephone_number": "719-671-4629",
            "fax_number": "719-561-8469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST STE 208",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032656",
            "telephone_number": "719-564-4336",
            "fax_number": "719-561-8469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHEK",
        "first_name": "GREGORY",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "NP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-27",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "5441",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "173720-5414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333409528",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE RXN",
            "identifier": "RXN 08-123",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.